(Stroke. 1997;28:957-960.)
© 1997 American Heart Association, Inc.
Articles |
Hemorrhagic Transformation in Acute Ischemic Stroke
Potential Contributing Factors in the European Cooperative Acute Stroke Study
From the Department of Neurology, Hôpital de Rangueil, University of Toulouse (France) (V.L.); the Department of Neuroradiology, University of Dresden (Germany) (R. von K.); the Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, Calif (G. del Z.); and Karl Thomae GmbH and Boehringer Ingelheim, Biberach, Germany (E.B.).
Correspondence to Dr V. Larrue, Service de Neurologie, Hôpital de Rangueil, 31403 Toulouse Cedex 04, France.
Background and Purpose Recent studies suggest that thrombolytic therapy may be of benefit to patients with acute ischemic stroke. However, the treatment also carries a significant risk of hemorrhagic transformation (HT). The purpose of this study was to select potential contributors to HT.
Methods We provide an explanatory analysis of the European Cooperative Acute Stroke Study (ECASS) data. ECASS was a multicenter, placebo-controlled, randomized trial of recombinant tissue plasminogen activator in ischemic stroke, within 6 hours of symptom onset, which enrolled 620 patients. HTs were classified into either hemorrhagic infarction or parenchymal hemorrhage according to their CT scan appearance. We used logistic regression analysis to select potential contributing factors to each type of HT.
Results The severity of initial clinical deficit (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.6 to 4.0) and the presence of early ischemic changes on CT scan (OR, 3.5; 95% CI, 2.3 to 5.3) were associated with increased risk of hemorrhagic infarction. Increasing age (in decades; OR, 1.3; 95% CI, 1.0 to 1.7) and treatment with recombinant tissue plasminogen activator (OR, 3.6; 95% CI, 2.1 to 6.1) were related to the risk of parenchymal hemorrhage.
Conclusions Since all potential contributing factors are readily discernible upon hospital admission, they should be used to improve selection of patients into future studies.
Key Words: cerebral hemorrhage • risk factors • stroke, acute • thrombolytic therapy
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S. Nakano, T. Iseda, H. Kawano, T. Yoneyama, T. Ikeda, and S. Wakisaka Correlation of Early CT Signs in the Deep Middle Cerebral Artery Territories with Angiographically Confirmed Site of Arterial Occlusion AJNR Am. J. Neuroradiol., April 1, 2001; 22(4): 654 - 659. [Abstract] [Full Text]
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 D. C. Tong, A. Adami, M. E. Moseley, and M. P. Marks Prediction of Hemorrhagic Transformation Following Acute Stroke: Role of Diffusion- and Perfusion-Weighted Magnetic Resonance Imaging Arch Neurol, April 1, 2001; 58(4): 587 - 593. [Abstract] [Full Text] [PDF]
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Y. Fujii, S. Takeuchi, A. Harada, H. Abe, O. Sasaki, and R. Tanaka Hemostatic Activation in Spontaneous Intracerebral Hemorrhage Stroke, April 1, 2001; 32(4): 883 - 890. [Abstract] [Full Text] [PDF]
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V. Larrue, R. von Kummer, A. Muller, and E. Bluhmki Risk Factors for Severe Hemorrhagic Transformation in Ischemic Stroke Patients Treated With Recombinant Tissue Plasminogen Activator : A Secondary Analysis of the European-Australasian Acute Stroke Study (ECASS II) Stroke, February 1, 2001; 32(2): 438 - 441. [Abstract] [Full Text] [PDF]
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H. C. Diener, E. B. Ringelstein, R. von Kummer, H. D. Langohr, H. Bewermeyer, H. Landgraf, M. Hennerici, D. Welzel, M. Grave, J. Brom, et al. Treatment of Acute Ischemic Stroke With the Low-Molecular-Weight Heparin Certoparin : Results of the TOPAS Trial Stroke, January 1, 2001; 32(1): 22 - 29. [Abstract] [Full Text] [PDF]
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D. C. Tong, A. Adami, M. E. Moseley, and M. P. Marks Relationship Between Apparent Diffusion Coefficient and Subsequent Hemorrhagic Transformation Following Acute Ischemic Stroke Stroke, October 1, 2000; 31(10): 2378 - 2384. [Abstract] [Full Text] [PDF]
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R. von Kummer, S. C. Jones, T. A. Kent, and D. K. Kim The Time Concept in Ischemic Stroke: Misleading Response Stroke, October 1, 2000; 31 (10): 2517 - 2527. [Full Text] [PDF]
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C. Cornu, F. Boutitie, L. Candelise, J. P. Boissel, G. A. Donnan, M. Hommel, A. Jaillard, and K. R. Lees Streptokinase in Acute Ischemic Stroke: An Individual Patient Data Meta-Analysis : The Thrombolysis in Acute Stroke Pooling Project Stroke, July 1, 2000; 31(7): 1555 - 1560. [Abstract] [Full Text] [PDF]
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M. A. Kalafut, D. L. Schriger, J. L. Saver, and S. Starkman Detection of Early CT Signs of >1/3 Middle Cerebral Artery Infarctions : Interrater Reliability and Sensitivity of CT Interpretation by Physicians Involved in Acute Stroke Care Stroke, July 1, 2000; 31(7): 1667 - 1671. [Abstract] [Full Text] [PDF]
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 I. L. Katzan, A. J. Furlan, L. E. Lloyd, J. I. Frank, D. L. Harper, J. A. Hinchey, J. P. Hammel, A. Qu, and C. A. Sila Use of Tissue-Type Plasminogen Activator for Acute Ischemic Stroke: The Cleveland Area Experience JAMA, March 1, 2000; 283(9): 1151 - 1158. [Abstract] [Full Text] [PDF]
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D. Tanne, M. J. Gorman, V. E. Bates, S. E. Kasner, P. Scott, P. Verro, J. R. Binder, J. M. Dayno, L. R. Schultz, and S. R. Levine Intravenous Tissue Plasminogen Activator for Acute Ischemic Stroke in Patients Aged 80 Years and Older : The tPA Stroke Survey Experience Stroke, February 1, 2000; 31(2): 370 - 375. [Abstract] [Full Text] [PDF]
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S. Nakano Reply AJNR Am. J. Neuroradiol., November 1, 1999; 20(10): 2022 - 2023. [Full Text]
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M. Fiorelli, S. Bastianello, R. von Kummer, G. J. del Zoppo, V. Larrue, E. Lesaffre, A. P. Ringleb, S. Lorenzano, C. Manelfe, and L. Bozzao Hemorrhagic Transformation Within 36 Hours of a Cerebral Infarct : Relationships With Early Clinical Deterioration and 3-Month Outcome in the European Cooperative Acute Stroke Study I (ECASS I) Cohort Stroke, November 1, 1999; 30(11): 2280 - 2284. [Abstract] [Full Text] [PDF]
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A. Jaillard, C. Cornu, A. Durieux, T. Moulin, F. Boutitie, K. R. Lees, and M. Hommel Hemorrhagic Transformation in Acute Ischemic Stroke : The MAST-E Study Stroke, July 1, 1999; 30(7): 1326 - 1332. [Abstract] [Full Text] [PDF]
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M. D. Ezekowitz and J. A. Levine Preventing Stroke in Patients With Atrial Fibrillation JAMA, May 19, 1999; 281(19): 1830 - 1835. [Abstract] [Full Text] [PDF]
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S. Nakano AJNR Am. J. Neuroradiol., May 1, 1999; 20(5): 946 - 946. [Full Text]
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C. Motto, A. Ciccone, E. Aritzu, E. Boccardi, C. De Grandi, A. Piana, and L. Candelise Hemorrhage After an Acute Ischemic Stroke Stroke, April 1, 1999; 30(4): 761 - 764. [Abstract] [Full Text] [PDF]
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J. Berrouschot, H. Barthel, J. Koster, S. Hesse, A. Rossler, W. H. Knapp, and D. Schneider Extracorporeal Rheopheresis in the Treatment of Acute Ischemic Stroke : A Randomized Pilot Study Stroke, April 1, 1999; 30(4): 787 - 792. [Abstract] [Full Text] [PDF]
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R. L. Zhang, Z. G. Zhang, M. Chopp, and J. A. Zivin Thrombolysis With Tissue Plasminogen Activator Alters Adhesion Molecule Expression in the Ischemic Rat Brain • Editorial Comment Stroke, March 1, 1999; 30(3): 624 - 629. [Abstract] [Full Text] [PDF]
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A. M. Demchuk, L. B. Morgenstern, D. W. Krieger, T. Linda Chi, W. Hu, T. H. Wein, R. J. Hardy, J. C. Grotta, and A. M. Buchan Serum Glucose Level and Diabetes Predict Tissue Plasminogen Activator–Related Intracerebral Hemorrhage in Acute Ischemic Stroke Stroke, January 1, 1999; 30(1): 34 - 39. [Abstract] [Full Text] [PDF]
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G. J DEL ZOPPO, R. VON KUMMER, and G. F HAMANN Ischaemic damage of brain microvessels: inherent risks for thrombolytic treatment in stroke J. Neurol. Neurosurg. Psychiatry, July 1, 1998; 65(1): 1 - 9. [Full Text]
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M. P. Sluss and M. P. Alexander More on Thrombolytic Therapy for Acute Stroke JAMA, April 22, 1998; 279(16): 1262 - 1262. [Full Text] [PDF]
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D. L. Schriger, M. Kalafut, S. Starkman, M. Krueger, and J. L. Saver Cranial Computed Tomography Interpretation in Acute Stroke: Physician Accuracy in Determining Eligibility for Thrombolytic Therapy JAMA, April 22, 1998; 279(16): 1293 - 1297. [Abstract] [Full Text] [PDF]
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T. N. t-P. S. S. Group Intracerebral Hemorrhage After Intravenous t-PA Therapy for Ischemic Stroke Stroke, November 1, 1997; 28(11): 2109 - 2118. [Abstract] [Full Text]
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